A study of periventricular leucomalacia and intraventricular haemorrhage in the preterm neonate.

In a prospective ultrasound study of 200 very low birthweight infants periventricular leucomalacia (PVL) was identified in 27 babies, 19 of whom developed cysts and eight at the echodense phase. Periventricular echodensity of more than two weeks duration but without cystic degeneration (prolonged flare) was found in a further 25 babies. Intraventricular haemorrhage (IVH) was detected in 107 babies. Only eight of these babies had parenchymal "extension" and of these five had associated abnormality of the contralateral hemisphere (four PVL, one prolonged flare). Twenty-one of the babies with smaller haemorrhages also developed PVL and a further ten had an associated prolonged flare. Sixty- nine infants (34.5% of the total) had no ultrasound abnormality. Autopsy was performed on 30 of the 42 babies who died (60 hemispheres). The accuracy of ultrasound diagnosis for periventricular haemorrhage was 88% with sensitivity of 91% and specificity 85%. The corresponding figures for PVL were 88%, 81% and 92% respectively. Three hemispheres which had shown prolonged flare on ultrasound were macroscopically normal but on microscopy showed extensive spongiosis and microcalcification of the periventricular white matter. Periventricular haemorrhage showed a sharp decline in frequency after 30 weeks of gestation; there was no such clear-cut relationship to birthweight. Other significant risk factors for haemorrhage were vaginal delivery, acidosis, hypercapnia, positive pressure ventilation, coagulation disorder, arrythmia, number of blood transfusions, tolazoline therapy, treatment with alkali, surgery and systolic blood pressure above 55 mmHg. A reduced risk with poor intrauterine growth and anaemia probably reflect a relatively greater gestation and a healthier infant respectively. Significant for PVL were a lower gestation, acidosis, hypercapnia, positive pressure ventilation, pneumothorax, coagulation disorder, hyperbilirubinaemia, number of blood transfusions and surgery; again anaemia showed a reduced risk. Pneumothorax, hyperbilirubinaemia and negative correlation with anaemia strongly predicted both PVL (cystic and echodense) and prolonged flare adding further evidence that the latter appearance is part of the PVL spectrum albeit at the milder end.